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HHS issued final rules for health insurance exchanges, including rules for advance payments of premium tax credits, reduced cost-sharing for lower-income enrollees and premium stabilization programs. The rules establish time frames for issuing refunds if advance payments of premium tax credits or cost-sharing reductions are incorrectly applied, or if an enrollee is incorrectly assigned to a standard plan without cost-sharing reductions. The rules also cover oversight of insurers and state exchanges.

Related Summaries

Many consumers who are eligible for the Affordable Care Act's cost-sharing subsides do not get those subsidies because they enroll in health plans based on premium alone, an Avalere Health study found. Eligible consumers often enroll in bronze-level plans, but the subsidies are available only with silver-level plans. "It's really easy to demonstrate how a tax credit will lower your premium, but it's harder to visualize how cost-sharing reductions lower out-of-pocket costs," said study leader Elizabeth Carpenter. "It's harder still to know how your out-of-pocket costs will change from year to year."

A family that qualified for tax credits and cost-sharing for a marketplace plan under the Affordable Care Act would likely still have access to that plan after one of the spouse's employment status changes, but they might no longer qualify for premium assistance or cost-sharing. Medicare-eligible individuals who have health coverage under a spouse's plan may delay enrolling in a Part B plan without penalty until eight months after coverage ends, and the same exemption applies for Part D if the spouse's plan includes prescription drug coverage.

Changes in income after open enrollment ends under the Affordable Care Act are considered among the special circumstances under which people may change insurance plans. If eligibility for tax credits or cost-sharing subsidies changes during the plan year, enrollees have 60 days to switch plans.

CMS has released a proposed rule containing additional guidance on health insurance exchanges. The proposed rule addresses cost-sharing reductions and how consumers may pay premiums, and it allows states with federally run individual marketplaces to run a Small Business Health Options Program.